VAGINAL PROLAPSE
A young nulliparous woman has 3rd-degree uterovaginal prolapse without any cystocele or rectocele. There is no stress incontinence. Uterocervical length is 3 inches. All other symptoms are normal. The best treatment plan for her will be :
| A |
Observation and reassurance till childbearing is over |
|
| B | Shirodkar’s vaginal repair | |
| C | Shirodkar’s abdominal sling | |
| D |
Fothergill’s operation |
A young nulliparous woman has 3rd-degree uterovaginal prolapse without any cystocele or rectocele. There is no stress incontinence. Uterocervical length is 3 inches. All other symptoms are normal. The best treatment plan for her will be :
| A |
Observation and reassurance till childbearing is over |
|
| B |
Shirodkar’s vaginal repair |
|
| C |
Shirodkar’s abdominal sling |
|
| D |
Fothergill’s operation |
Ans. is c i.e. Shirodkar abdominal sling
Abdominal sling operations are designed for young women suffering from second or third-degree uterovaginal prolapse and who are desirous of retaining their childbearing and menstrual functions.
The objective of these operations is to buttress the weakened supports (Mackenrodt and uterosacral ligaments) of the uterus by providing a substitute in the form of Nylon or Dacron tapes, used as slings to support the uterus.
The operations in common practice are :
- Abdominal-cervicopexy
- Shirodkar’s abdominal sling operation
- Khanna’s abdominal sling operation.
Treatment :
- For young nulliparous women with 2° or 3° uterovaginal prolapse- Abdominal sling operation (e.g. Purandare, Shirodkar, Khanna)
- For a parous woman in the early weeks of pregnancy-Ring pessary in the first trimester of pregnancy.
- For a parous woman in pregnancy with 2° or 3° prolapse at 28 weeks-Ring pessaries till childbirth and a few weeks after and then Fothergill’s repair.
- For < 40years multipara, desirous of retaining menstrual function and reproductive function with 2° or 3° prolapse-Fothergill’s repair
- For women > 40 years completed family size-Mayoward’s vaginal hysterectomy with pelvic floor repair.
- For elderly menopause patients with advanced prolapse-Lefort’s repair.
- For enterocele-Moscowitz repair
- For vault prolapse- Right transvaginal sacrospinous colpopexy
| A |
Purandare and Mnatre sling operation |
|
| B |
Virkud’s sling operation |
|
| C |
Mangeshkar’s Laparoscopic technique |
|
| D |
Neeta Warty’s Laparoscopic modification of shirodkar’s operation |
Purandare and Mnatre sling operation
Urinary incontinence in uterovaginal prolapse is mostly is due to :
| A |
Detrusor instability |
|
| B |
Stress incontience |
|
| C |
Urge incontinence |
|
| D |
True incontinence |
Stress incontience
Treatment of choice in a multiparous female with 2nd degree uterovaginal prolapse is :
| A |
Fothergill’s operation |
|
| B |
Hysterectomy with pelvic floor repair |
|
| C |
Fothergill’s operation with tubal ligation |
|
| D |
Hysterectomy only |
Fothergill’s operation with tubal ligation
Cystocele is formed by of the bladder :
| A |
Base |
|
| B |
Superior surface |
|
| C |
Trigone |
|
| D |
Posterior |
Base
The most common type of genital prolapse is:
| A |
Cystocele |
|
| B |
Procidentia |
|
| C |
Rectocele |
|
| D |
Entrocele |
Cystocele is the most frequent type of genital prolapse.
Ref: Glenn’s Urologic Surgery, Page 326 ; Shaw’s Textbook of Gynaecology, 11th Edition, Page 358 ; A Comprehensive Textbook of Obstetrics and Gynecology By Sadhana Gupta, 2011, Page 63
